阿加曲班联合双抗治疗72 h内脑梗死的疗效观察及安全性评估

目的观察阿加曲班联合阿司匹林+氯吡格雷治疗72 h内脑梗死的疗效及安全性评估。方法2018-07—2019-10泰州市中医院收治72 h内急性脑梗死患者80例,随机分为2组,研究组40例,常规组40例。常规组予阿司匹林联合氯吡格雷抗血小板聚集,同时予清除氧自由基、调控血压、血糖控制、改善脑代谢等治疗。研究组在常规组的基础上加用阿加曲班注射液,首日和次日以60 mg剂量于24 h内持续静脉泵入,自第3天起,剂量调整为10 mg 2次/d,每次于3 h内静脉泵入,持续使用5 d;比较治疗前、治疗7 d、14 d后凝血功能(PT、TT、APTT、FIB)和血小板(PLT)计算变化,比较治疗前、治疗后7d、14 d NIHSS评分、Barthel生活指数、临床疗效。结果研究组患者治疗前凝血功能与治疗7 d、14 d后差异无统计学意义(P>0.05),虽血小板计数2组均降低,但差异无统计学意义(P>0.05)。研究组与常规组患者治疗前NIHSS评分和Barthel指标数,2组差异无统计学意义(P>0.05),治疗7 d、14 d后2组评分均有明显升高(P<0.05),但研究组NIHSS评分和Barthel指标均好于常规组,差异有统计学意义(P<0.05)。研究组治疗后总有效率82.5%,明显高于对照组65.0%(P<0.05),且出血风险无明显增加。结论阿加曲班应用于急性脑梗死的临床治疗具有较好的疗效和安全性。

Efficacy observation and safety evaluation of argatroban combined with double anti in the treatment of cerebral infarction within 72 hours

Objective To observe the efficacy and safety of argatroban combined with aspirin+clopidogrel in the treatment of cerebral infarction within 72 hours.Methods Eighty patients with acute cerebral infarction within 72 hours admitted to our hospital from July 2018 to December 2019 were randomly divided into two groups,40 in the study group and 40 in the conventional group.The conventional group was treated with anti-platelet aggregation,scavenging oxygen free radicals,regulating blood pressure,blood sugar control,Improve brain metabolism and other treatment.The study group used argatroban on the basis of the conventional group.Continuous intravenous pumping for 60mg within 24h on the first day and the next day.From the 3rd day onwards,the dose was adjusted to 10 mg twice daily,and each time it was intravenously pumped within 3 hours,continued use for 5 days.Changes of coagulation function(PT,TT,APTT,FIB)and platelet(PLT)before and after treatment were compared.NIHSS scores,Barthel life index and clinical efficacy were compared before and after treatment at 7 and 14 days.Results There was no significant difference in coagulation function between the two groups and those after 7 and 14 days of treatment(P>0.05).Although platelet count was reduced in both groups,there was no significant difference between the two groups(P>0.05).There was significant difference between the study group and the routine group in the pre-treatment NIHSS score and Barthel treatment group(P>0.05).The score of the study group was significantly increased after treatment(P<0.05),and the score of the routine group was also improved(P<0.05),and the patients in the study group scored better than the conventional group(P<0.05),the difference was statistically significant.The total effective rate of the study group was 82.5%after treatment,which was significantly higher than that of the control group(65.0%).and the risk of bleeding did not increase significantly.Conclusion The application of argatroban in the clinical treatment of acute cerebral infarction has good efficacy and safety.